Monday, 24 March 2014

Trial by Author

Roger Watson, Editor-in-Chief

Periodically,
authors scrutinise what is published in journals and then publish it. I welcome this and, with respect to h-indices
(Thompson & Watson 2010), open access (Watson et al. 2012), peer review (Watson 2012), authorship (Hayter et al. 2013) and citations (Hunt et al. 2013, Watson et al. 2013) I have done some of this myself. Publishing about publishing is increasingly
common and, while some may see this as futile self-absorption, it is important
in exposing and improving standards.

A
recent JAN paper by Chiavetta et al. (2014) considers whether there is
a difference in methodological quality between positive and negative published
clinical trials. They conclude that
there is and that negative trials tend to do better when scored using the Jadad
scale which looks at randomisation, blinding and how all patients are accounted
for. The years studied were 2010-2012 and, since the journals they analysed include JAN, my attention was drawn to this paper by our Managing Editor.

Ideally,
there should be no difference in the methodological quality of positive or negative
clinical trials and none of us - without appropriate qualification or description
(e.g. pragmatic, single-blind, quasi-experimental) - should be publishing items
labelled clinical trials that are not described fully. For the details of the disparate points
between trials I urge you to read the paper; of more interest to me as
Editor-in-Chief of JAN is ‘why?’. Why was there a difference and, of course,
what can we do about it?

The
authors speculate that it is still hard to publish the results of negative clinical
trials; this should not be true but it may be. At JAN we do not have a policy
of not publishing negative trials and I hope we convey that message. Nevertheless, as I travel the world and give writing
workshops I am frequently asked about our policies on negative trials. Clearly, people do find it hard to publish
these and whatever efforts we are making to dispel this, we are not making them
strongly enough.

The argument
by the authors, therefore, runs as follows: it is harder to publish negative trials
and they come under greater scrutiny than positive trials; thus the standard of
their publication is driven up. However,
editors and reviewers like positive trials and they receive less scrutiny and ‘slip
the net’ of the reviewing and editing process. If this is true then we need to work harder to obviate this as it is
surely a contributory factor to publication bias and this is bad because poor
positive results are published and exaggerated. This leads to misuse of resources and could even endanger patients.

The
solution proposed by Chiavetta et al.
(2104) includes the use of the CONSORT
guidelines which we
do recommend in JAN there may be
a case for emphasising this in our guidelines and strengthening its implementation
by authors, reviewers and editors.